Provider Demographics
NPI:1548479785
Name:DEJONG, DEBRA DIANNE (LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:DIANNE
Last Name:DEJONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13901 NE 175TH ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8548
Mailing Address - Country:US
Mailing Address - Phone:206-931-6336
Mailing Address - Fax:
Practice Address - Street 1:13901 NE 175TH ST
Practice Address - Street 2:SUITE L
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8548
Practice Address - Country:US
Practice Address - Phone:206-931-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist